1 Form 7.01A Rev. 4/2018 IN THE COURT OF COMMON PLEAS DOMESTIC RELATIONS DIVISION MEDINA COUNTY, OHIO Judge Mary R. Kovack DISSOLUTION CHECKLIST (without children) PETITIONER - 1: C OUNSEL : PETITIONER - 2: C OUNSEL : C ASE NUMBER : M ARRIAGE DATE : Pursuant to Loc. R. 7.01 (check off if needed and included) CASE DESIGNATION FORM PETITION FOR DISSOLUTION Statement regarding jurisdiction and venue Signed by attorneys/parties If applicable, the a WAIVER OF SERVICE executed by both parties SEPARATION AGREEMENT, original, executed by both parties Disclosure statement Personal property division addressed (including vehicles) Real property division addressed Financial division of property addressed (accounts, investments, life insurance, etc.) Pension division addressed Liabilities and debt division addressed Taxes Spousal support addressed - including jurisdiction Spousal support must have an effective date and must address duration Mandatory CSEA language, if spousal support will go through CSEA JUDGMENT ENTRY DECREE OF DISSOLUTION Jurisdiction and venue requirements met Contains date of hearing Signed by attorneys/parties Contains mandatory CSEA language if applicable Statement that wife (1) wishes to be restored to former name or (2) does not wish to be restored to a former name Payment of court costs and attorney fees (please acknowledge that court costs must be paid from any deposits first; then, indicate any additional formula for sharing them between the parties, as appropriate) American LegalNet, Inc. www.FormsWorkFlow.com